THROAT INFECTIONS 331 



ture; abundance of streptococci in a smear from an ulceration or bit of membrane, 

 however, is of etiological import. 



By staining with Neisser's method it is possible to make an imme- 

 diate diagnosis of diphtheria from a smear from a piece of membrane 

 in about 25 % of cases. It is well, however, to always culture such 

 material. The toluidin blue stain of Ponder is the best stain for 

 diphtheria. 



Material from the throat is ordinarily best obtained with a sterile copper-wire 

 cotton-pledget swab. The platinum loop usually bends too easily. A sterile for- 

 ceps may be more convenient for obtaining particles of membrane. It is believed 

 that ulcerative conditions of the throat, associated with the presence of the large 

 fusiform bacillus and delicate spirillum, which make the picture of Vincent's angina, 

 are more common than is usually so considered. 



In Giemsa stained smears from the dirty membrane covering the ulcerated area 

 of Vincent's angina there are usually two types of the fusiform bacillus to be seen; 

 one rather slender, pale blue with maroon dots at either end, the other rather thicker 

 and of a uniform maroon staining. The spirilla are from 10 to 18 microns long and 

 the fusiform bacilli from 5 to 7 microns. 



As a rule, only cultures on serum are made and very rarely direct smears. If a 

 smear were always made and stained by Gram's method (with a contrast stain of 

 dilute carbol fuchsin) at the same time the culture was made, it is probable that 

 much information of value would be obtained. 



The B. fusiformis is an anaerobe which gives a fetid odor but culturally has no 

 distinct characteristics. The spirillum has not been cultivated. It has been 

 thought that the bacillus and spirillum are different stages of the same organism. 

 At times aggregations of the fusiform bacillus give the appearance of branching so 

 characteristic of diphtheria organisms. Being Gram negative, however, the differ- 

 entiation is easily made the B. diphtherias being Gram positive. Again the 

 attenuated ends of the fusiform bacillus are diagnostic. 



Direct smears are the procedure of choice in streptococcal and 

 pneumococcal anginas as well as in Vincent's angina. 



Unless very familiar with the morphology of Treponema pallidum and using 

 Giemsa's staining procedure, we should be very conservative in reporting such an 

 organism from suspected syphilitic ulcerations of the throat. 



The thrush fungus (Endomyces albicans) may be easily demonstrated in a Gram- 

 stained specimen as violet mycelial structures. 



Yeasts due to food particles are not infrequently observed in smears and cultures 

 from the mouth. 



Actinomycosis may develop about a carious tooth and the finding of the ray 

 fungus in the granules from the pus may give the diagnosis. 



Amoebae and flagellates have been reported from the mouth. Also in the re- 

 markable disease "halzoun," flukes have been found to be the cause of the asphyxia. 



